I-Graft versus host disease (GvHD), sisiphumo esingalindelekanga esinokuvela emva kokuba ukufakelwa kwe-allogeneic.
Yintoni i-graft versus host disease (GvHD)?
I-Graft versus host disease (GvHD) yingxaki eqhelekileyo yofakelo lwe-allogeneic stem cell. Kwenzeka xa iiseli ze-T zesistim somzimba esitsha, ziqaphela iiseli zomamkeli njengezangaphandle, kwaye zihlasele. Oku kubangela imfazwe phakathi 'kwe-graft' kunye 'nomkhosi'.
Ibizwa ngokuba yi-graft versus host, kuba 'igrafti' sisixokelelwano sokhuselo lomzimba esinikelweyo, kwaye 'umamkeli' sisigulana esifumana iiseli ezinikezelweyo.
I-GvHD yingxaki enokuthi yenzeke kuphela kuyo i-allogeneic transplants. Ukufakelwa kwe-allogenic kubandakanya iiseli ze-stem ezinikezelwe ukuba isigulane sifumane.
Xa umntu efakelwa uqhaqho-fakelo apho afumana khona iiseli ezizezakhe, oku kubizwa ngokuba yi- ukufakelwa kwe-autologous. I-GvHD ayiyongxaki enokuthi yenzeke kubantu abafumana ukufakelwa kwakhona kweeseli zabo.
Ugqirha uya kuhlola izigulane ezine-GvHD rhoqo njengenxalenye yokhathalelo olulandelelweyo emva kokuxilongwa i-allogeneic transplants. Kwinxalenye nganye yomzimba echaphazelekayo yi-GvHD engapheliyo, amanqaku phakathi kwe-0 (akukho mpembelelo) kunye ne-3 (impembelelo enzima) inikwe. Amanqaku asekelwe kwimpembelelo iimpawu ezinayo kubomi bemihla ngemihla kwaye oku kunceda oogqirha ukuba bathathe isigqibo malunga nonyango olungcono lwesigulane.
Iindidi ze-graft versus host disease (GvHD)
I-GvHD ihlelwa njenge 'acute' okanye 'engapheliyo' ngokuxhomekeke ekubeni isigulana siyifumana nini kunye neempawu kunye neempawu ze-GvHD.
I-graft ebukhali ngokuchasene nesifo somkhosi
- Iqala kwiintsuku zokuqala ezili-100 emva kokutshintshwa
- Ngaphezulu kwe-50% yezigulane ezinokufakelwa kwe-allogenic, amava oku
- Ngokuqhelekileyo kwenzeka malunga neeveki ezi-2 ukuya kwezi-3 emva kofakelo. Olu phawu lweveki ezi-2 ukuya kwezi-3 kuxa iiseli ezitsha ze-stem ziqala ukuthatha umsebenzi we-immune system kwaye zenze iiseli zegazi ezintsha.
- I-Acute GvHD ingenzeka ngaphandle kweentsuku ze-100, oku ngokuqhelekileyo kwenzeka kuphela kwizigulane eziye zafumana inkqubo yokunciphisa imeko ngaphambi kokutshintshwa.
- Kwi-acute GvHD, igrafti iyala umamkeli wayo, hayi umamkeli owala uxhulumaniso. Ngelixa lo mgaqo ufana kwi-GvHD ebukhali kwaye engapheliyo, iimpawu ze-Acute GvHD zahlukile kwezo zingapheliyo.
Ubunzima be-Acute GvHD buhlelwa ukusuka kwisigaba I (esincinci kakhulu) ukuya kwisigaba IV (esinzima), le nkqubo yokuhlela inceda oogqirha ukuba benze isigqibo ngonyango. Ezona ndawo zixhaphakileyo ze-acute GvHD zezi:
Gastrointestinal tract: Urhudo olunokuba namanzi okanye lube negazi. Isicaphucaphu kunye nokugabha okuhamba nentlungu yesisu, ukwehla kobunzima kunye nokuncipha kokutya.
Ulusu: Kukhokelela kwirhashalala elibuhlungu nelirhawuzelelayo. Idla ngokuqala ezandleni, ezinyaweni, ezindlebeni nasesifubeni kodwa inokusasazeka kuwo wonke umzimba.
Isibindi: Isibindi: unobangela wejaundice ekukukwanda kwe'bilirubin' (into ebandakanyeka ekusebenzeni kwesibindi okuqhelekileyo) ejika ubumhlophe bamehlo lube tyheli nolusu.
Iqela elinyangayo kufuneka livavanye isigulane rhoqo nge-GvHD njengenxalenye yokhathalelo olulandelayo.
Ukuxhunyelelwa okungapheliyo ngokuchasene nesifo somkhosi
- I-GvHD engapheliyo yenzeka ngaphezu kweentsuku ezili-100 emva kofakelo.
- Nangona inokuthi yenzeke nakweyiphi na indawo emva kokutshintshwa, ibonwa ngokuqhelekileyo kunyaka wokuqala.
- Izigulane ezine-Acute GvHD zisemngciphekweni ophezulu wokuba ne-GvHD engapheliyo.
- Malunga ne-50% yezigulana ezifumana i-GvHD ebukhali ziya kuqhubeka nokufumana i-GvHD engapheliyo.
- Inokuchaphazela nabani na othumele i-stem cell transplant.
IGvHD engapheliyo ihlala ichaphazela:
- Umlomo: kubangela umlomo owomileyo nobuhlungu
- Ulusu: Irhashalala eluswini, ulusu luba luhlaza kwaye lurhawuzelelwe, luqina ulusu kwaye lutshintshe umbala walo kunye nethoni.
- Amathumbu: ukuqunjelwa, urhudo, isicaphucaphu, ukugabha kunye nokwehla kobunzima obungachazwanga.
- Isibindi: sihlala sibonakalisa iimpawu ezifana nentsholongwane ye-hepatitis
I-GvHD engapheliyo inokuchaphazela nezinye iindawo, ezifana namehlo, amalungu, imiphunga kunye namalungu angasese.
Iimpawu kunye neempawu ze-graft versus host disease (GvHD)
- I-Rash, kubandakanywa ukutshisa kunye nokubomvu kwesikhumba. Le rhashalala idla ngokubonakala kwintende yesandla kunye neenyawo zeenyawo. Inokubandakanya umboko kunye nezinye iziphelo.
- Isicaphucaphu, ukugabha, urhudo, ukuqaqanjelwa sisisu kunye nokuphelelwa ngumdla wokutya kunokuba ziingoma zeGvHD yesisu.
- Ukuba tyheli kwesikhumba kunye namehlo (oku kubizwa ngokuba yi-jaundice) kunokuba luphawu lwe-GvHD yesibindi. Ukungasebenzi kakuhle kwesibindi kunokubonwa kwezinye iimvavanyo zegazi.
- Umlomo:
- Umlomo omile
- Ukonyuka kobuntununtunu bomlomo (kushushu, ukubanda, i-fizz, ukutya okuneziqholo njl.njl.)
- Kunzima ukutya
- Isifo seentsini kunye nokubola kwamazinyo
- Isikhumba:
- Rash
- Ulusu olomileyo, oluqinileyo, olurhawuzelelwa
- Ukuqina kunye nokuqiniswa kwesikhumba okunokuthi kubangele izithintelo zokuhamba
- Umbala wolusu utshintshile
- Ukunganyamezeli utshintsho lweqondo lokushisa, ngenxa yeengqungquthela ze-sweat ezonakalisiweyo
- Iikhonkwane:
- Utshintsho kwi-nail texture
- Izikhonkwane eziqinileyo, ezinqabileyo
- Ilahleko yezikhonkwane
- Umzila wesisu:
- Ukuphelelwa kwesidlo
- Ukulahleka kwesisindo esingachazwanga
- Ukuvutha
- Uhudo
- Ukuqhaqha kwesisu
- Imiphunga:
- Ukuqhawukelwa ngumphefumlo
- Ukukhohlela okungapheliyo
- Ukugubha
- Isibindi:
- Ukudumba esiswini
- Umbala otyheli wolusu/amehlo (jaundice)
- Ukungasebenzi kakuhle kwesibindi
- Izihlunu kunye namalungu:
- Ubuthathaka bemisipha kunye nokukrazula
- Ukuqina okudibeneyo, ukuqina kunye nobunzima bokwandisa
- Izitho zangasese:
- Ibhinqa:
- Ubufazi ukoma, ukurhawuzelelwa kunye neentlungu
- Izilonda kwilungu lobufazi kunye namanxeba
- Ukuncipha kwilungu lobufazi
- Ukwabelana ngesondo okunzima/kubuhlungu
- Indoda:
- Ukuncipha kunye nokukrala kwe-urethra
- Ukurhawuzelelwa kunye namanxeba kwisingxobo kunye nakumthondo
- Ukurhawuzelelwa ngumthondo
- Ibhinqa:
Unyango lwe-graft versus host disease (GvHD)
- Ukwandisa i-immunosuppression
- Ukulawulwa kwe-corticosteroids efana ne-Prednisolone kunye ne-Dexamethasone
- Kwi-GvHD yesikhumba esisezantsi, i-topical steroid cream ingasetyenziswa
Kunyango lwe-GvHD olungaphenduliyo kwi-corticosteroids:
- Ibrutinib
- I-Ruxolitinib
- I-Mycophenolate mofetil
- Sirolimus
- Tacrolimus kunye neCyclosporin
- I-antioclonal antibodies
- I-Antithymocyte Globulin (ATG)
